AS A YOUNG doctor working in Africa 30 years ago, I was often shocked at the frequency with which grandmothers, aunts, and sisters were called on to take responsibility for the care of orphaned newborn babies. Never would I have believed that well into the 21st century, every day 1500 women around the globe would die from complications related to pregnancy, with their babies being handed to caring relatives, disproportionately represented among the world's poorest families.

The impact of 500,000 women dying each year from complications related to pregnancy and childbirth is enormous. The UNICEF annual report The State of the World's Children 2009, released yesterday, highlights the importance of maternal health for child health, and the need to create a supportive environment for healthy mothers to have healthy children.

The major reasons women die in pregnancy are bleeding, infection, unsafe abortion, a pregnancy specific condition known as eclampsia that requires early detection and skilful management, and obstructed labour. In some regions, malaria is a major contributor.

So why do women die from these largely preventable or manageable complications? As with so many conditions of the poorest countries, the answer is complex: poverty, leading to sub-optimal health and education for young women; limited access to preventive and curative services; failure to give priority to the needs of women and children; lack of antenatal care or trained birth attendants and facilities.

It is not just the immediate consequences of illness in pregnancy that make a difference. More and more evidence suggests that a mother's health during pregnancy has important implications, not just for the baby's survival, but also for lifelong health. Safe motherhood improves the health of mothers and their families but also has a profound effect on their ability to work, and so generate income and produce for their families, especially children, and for the community. Continued...